Acost control policy that is in effect at your organization
Research a cost control policy that is in effect at your organization or one that you
research. In doing so, you will detail the impact this policy has on the organization, its unintended consequences,
and a possible alternative.
All healthcare organizations must be aware of cost controls, regardless of nonprofit or for-profit status.
Managing costs at all levels of the organization affects the bottom line, which has a direct effect on all aspects of
the organization. This assessment is designed to help you analyze why organizational policies are put in place. In
addition, it will help you understand the role of operations in a healthcare setting, which is to ensure a high
quality of care is maintained across all departments.
Health care organization could be a hospital system like Banner Health or a skilled nursing facility located in
your town, or a surgical outpatient clinic. You should choose one facility and pick one policy and write a
cohesive paper or power point about it. You should NOT choose a federal generic broad policy like Obama
Care/Affordable Care Act or Medicare or Medicaid.
You are working in an organization that is conducting an audit of a determined number of policies to determine
if they are effective in their current state or if improvements and updates are needed (and alternatives need to be
created).
Your first step is to find a policy at a healthcare organization related to cost controls. Include the following in
your report.
When was the policy put in place?
Was it adopted system-wide, in one department, or multiple departments?
What does the policy address?
What is the potential impact of not following the policy at the organizational level? Unit level? Individual level?
Explain how the policy impacts fiscal aspects of the organization:
How does the policy act as a cost control?
Describe how the policy impacts the quality of patient care:
Does the policy improve efficiency?
Are the goals to improve care and reduce costs?
Sample Solution
Cost Control Policy: Prior Authorization for Specialty Medications
Organization: A large, multi-hospital health system in the United States
Policy Implementation:
- Date: Implemented in 2015
- Scope: System-wide policy, affecting all departments and facilities within the organization
Policy Address:
This policy requires prior authorization for certain specialty medications, particularly those with high costs or limited clinical evidence. The goal is to ensure that these medications are prescribed appropriately and only when necessary.
Full Answer Section
Potential Impact of Non-Compliance:- Organizational Level: Non-compliance with the policy can lead to increased healthcare costs, reduced profitability, and potential penalties from payers.
- Unit Level: Departments may experience budget overruns and difficulties in managing their operating expenses.
- Individual Level: Providers may face disciplinary action for prescribing non-authorized medications.
Impact on Fiscal Aspects:
- Cost Control: The policy acts as a cost control measure by limiting the use of expensive medications, reducing drug expenditures, and improving medication adherence.
- Financial Stability: Adherence to the policy can contribute to the financial stability of the organization by preventing unnecessary costs and ensuring that resources are allocated effectively.
Impact on Quality of Patient Care:
- Efficiency: The policy can improve efficiency by streamlining the medication approval process and reducing administrative burden on providers.
- Patient Outcomes: While the policy may have some unintended consequences, such as delays in patient access to medications, it can ultimately improve patient outcomes by ensuring that medications are prescribed appropriately.
Goals:
The primary goals of this policy are to:
- Reduce healthcare costs
- Improve medication adherence
- Ensure appropriate use of specialty medications
- Maintain high-quality patient care
Overall, the prior authorization policy for specialty medications has been effective in achieving its objectives. However, it is important to monitor the policy's impact and make adjustments as needed to address any unintended consequences or challenges.